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tional Data Collection of Adverse Events
of Anti-HIV Drugs) is a large, seven-year
observational study from 11 cohorts from
Europe, Australia, and the U.S. At CROI,
a sub-study analysis from D:A:D was
important enough that many activists felt
it should have been in a late breaker presentation,
rather than a less signifi cant poster
discussion. It showed that people using
Ziagen had a 90% increased risk of having
a heart attack, although the overall number
of heart attacks was very small. Th ere
was also a 49% increased risk with use of
Videx but not the other nucleosides studied,
such as Retrovir and Zerit, which have
been the usual suspects with increased lipid
levels and insulin resistance—risk factors
associated with heart attacks. Th e risk was
only associated with people currently taking
Ziagen and Videx, not with those who
had a history of using these medications
more than six months, suggesting that it
is reversible upon stopping the drugs. One
caveat with this study is that those subjects
using Ziagen or Videx also had higher rate
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15th Annual Retrovirus Conference (CROI), Boston, February 3–6, 2008
of cardiovascular risks such as smoking,
diabetes, or high blood pressure. Th is was
also not a randomized controlled study, so
results should be weighed with that in mind.
However, the authors concluded that there
was no inherent bias. Medical providers are
waiting for more information. HIV specialist
Joel Gallant, M.D., from Johns Hopkins
University, told Th eBody.com, “If there’s a
risk of a heart attack from the drug [abacavir],
it’s small in comparison with the risk of
smoking cigarettes or sitting on the couch
eating potato chips. You have to be realistic
and put this all in perspective.”
SMART study
On the other hand, the pros of staying
on treatment are being proven in SMART
sub-studies. Th e SMART study was a large
randomized, controlled treatment interruption
study closed in January 2006 because
there were more complications and deaths
in those discontinuing treatment than
those randomized to stay on treatment. 85
out of more than 5,000 people died in the
SMART study, which is providing a wealth
of data regarding the eff ectiveness of antiviral
therapy and the harms of stopping treatment.
At CROI there was information looking
at what occurs when people restarted
therapy aft er treatment interruption. Th ose
PA • May / June 2008 • tpan.com • positivelyaware.com
Positively Aware
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